10.1002/9781118797914

Vollständiger Abstract

Worum geht es in dieser Arbeit?

<h4>Aim</h4>To evaluate the efficacy of establishing a nurse-coordinated and guideline-driven care by advanced stroke nurses for acute ischemic stroke (AIS).<h4>Background</h4>Specialised nursing care is usually not integrated enough to provide high quality of interdisciplinary care for patients with AIS.<h4>Design</h4>A prospective study with retrospective controls.<h4>Method</h4>A total of 231 patients with AIS were prospectively enrolled to receive the nurse-coordinated and guideline-driven care for intravenous thrombolysis (prospective cohort). A retrospective cohort using propensity-score matching at a 1:1 ratio retrieved reviews of 231 cases. The primary endpoint was early major improvement in the National Institute of Health Stroke Scale (NIHSS) scores at 24 h after thrombolysis. Secondary outcome measures included treatment time of each link at different stages, functional independence, EuroQoL 5-dimension three-level scale (EQ-5D-3L) scores and adverse events.<h4>Results</h4>The rate of early major improvement in NIHSS score was 57.19% and 42.0% in the prospective and retrospective cohorts with a rate ratio of 1.361 (95% CI: 1.127-1.643) indicating superiority (p = 0.002). A higher rate of functional independence was observed in the prospective cohort as compared to controls (77.9% vs. 68.8%, p = 0.035). The mean time from admission was 17.11 ± 9.64 min for imaging, 21.75 ± 8.42 min for femoral artery puncture and 51.43 ± 9.64 min for thrombolysis in the prospective cohort, which were shorter than those in controls (all p < 0.001). EQ-5D-3L scores were better in prospective cases than in controls within 90 days after thrombolysis (all p < 0.05). A lower incidence of symptomatic intracranial haemorrhage was observed in the prospective cohort, while no significant difference in mortality up to 90 days was found between the two cohorts.<h4>No patient or public contribution</h4>Although patients and the public were not directly involved in the design or conduct of this study, the research findings provide critical evidence that nursing-led, guideline-driven coordination directly improves the efficacy and safety in the management of patients with AIS by ensuring timely reaction, consistent application of evidence-based protocols and enhanced multidisciplinary teamwork.<h4>Trial registration</h4>Chinese Clinical Trial Registry: ChiCTR2200056818.

Abstract: PubMed · Datensatz